Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?-comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group.

Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture. Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008-2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments. Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. 38.4 months). Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs. 2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis. Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.

Healthy and wellbeing activities' promotion using a Big Data approach.

The aging population and economic crisis specially in developed countries have as a consequence the reduction in funds dedicated to health care; it is then desirable to optimize the costs of public and private healthcare systems, reducing the affluence of chronic and dependent people to care centers; promoting healthy lifestyle and activities can allow people to avoid chronic diseases as for example hypertension. In this article, we describe a system for promoting an active and healthy lifestyle for people and to recommend with guidelines and valuable information about their habits. The proposed system is being developed around the Big Data paradigm using bio-signal sensors and machine-learning algorithms for recommendations.

DietaDialisisQuiz. A multiplayer competitive serious game for learning during dialysis

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Renal Complex Cystic Masses: Usefulness of Contrast-Enhanced Ultrasound (CEUS) in Their Assessment and Its Agreement with Computed Tomography.

INTRODUCTION: Around 10 % of renal cell carcinomas (RCC) are cystic, while some benign cysts have complex appearance in conventional diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI). These renal complex cystic masses (RCCMs) are a challenging entity in urological practice and sometimes have a difficult management, requiring surgical removal. Contrast-enhanced ultrasound (CEUS) is a very sensitive test detecting microvascularization in real time, and it has been used in the diagnostic workup of these kinds of lesions. The aim of our study was to assess the diagnostic power of CEUS in the evaluation of RCCM. MATERIAL AND METHODS: This is a prospective observational study between April 2011 and July 2014. A total of 66 patients with 67 RCCMs were enrolled (Bosniak 2-4). Twenty-four patients underwent surgical removal of the RCCM. All participants underwent CEUS (experimental) and CT (control). All CEUS procedures were performed by a single high-experienced observer (urologist). Benign lesions were defined as those Bosniak 2-2F, and malignant were Bosniak 3-4. Statistical analysis was made measuring consistency (kappa index and Landis-Koch scale) and validity (sensitivity, specificity, positive and negative predictive values) of the study. RESULTS: Median size of RCCM measured by CEUS and CT was 3.8 cm (interquartile range (AIQ) 3.2-4.6) and 3.9 cm (AIQ 3.2-4.5), respectively. Kappa index shows good agreement between both tests (0.71; 95 % CI 0.57-0.85), both overall and stratified by categories according to Bosniak classification. CEUS has a sensitivity 100 %, specificity 81.4 %, positive predictive value 70.4 %, and negative predictive value 100 %. A total of eight RCCMs were discordant, and seven of eight classified as malignant by CEUS and not by CT. Of those seven lesions classified as malignant by CEUS, six (six of seven, 85.7 %) were malignant in the pathological exam. CONCLUSIONS: CEUS is a very useful tool for assessing RCCM, with good results in terms of consistency and validity. It has a good diagnostic power, with a sensitivity of 100 % and a negative predictive value of 100 %. Its main limitations are the experience required, a special software, and being observer-dependent.

Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation.

Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.

Estudio prospectivo de la procalcitonina como marcador diagnóstico de gravedad en la peritonitis secundaria / Prospective study of procalcitonin as a diagnostic marker of the severity of secondary peritonitis

Introducción Se ha demostrado que la procalcitonina (PCT) es un buen marcador de sepsis, ya que sus concentraciones en plasma aumentan cuanto más grave es la infección. El índice de Mannheim (MPI) es muy eficaz para evaluar el pronóstico de la peritonitis secundaria. El objetivo de este estudio es analizar si hay correlación entre las concentraciones de PCT preoperatorias y el MPI postoperatorio, así como el valor pronóstico de las cifras preoperatorias de PCT. Pacientes y método Estudio prospectivo sobre un total de 57 pacientes intervenidos entre diciembre de 2006 y agosto de 2008 por peritonitis secundaria y clasificados en 3 grupos (A: 23 pacientes, B: 24 pacientes y C: 10 pacientes) de menor a mayor gravedad del MPI. Los valores de procalcitonina preoperatoria se obtuvieron con el PCT-Q test (BRAHMS). Resultados El PCT-Q fue normal (<0,5ng/ml) en 19 pacientes del grupo A, en 2 pacientes del grupo B y en ninguno del grupo C (p<0,001). El PCT-Q de 2 10ng/ml se objetivó en 1 paciente del grupo A, 13 del grupo B y ninguno del grupo C (p<0,001). Un PCT-Q >10ng/ml se halló en los 10 pacientes del grupo C, en 6 pacientes del grupo B y en ninguno del grupo A (p<0,001). De un total de 19 pacientes ingresados en la unidad de cuidados intensivos (UCI), en 15 casos el PCT-Q fue >10ng/ml frente a 4 casos con PCT-Q<10ng/ml (p<0,001); 7 pacientes fallecieron, en todos ellos la PCT-Q fue >10ng/ml (p<0,001).Conclusiones La correlación entre PCT-Q preoperatoria y MPI postoperatorio es positiva y significativa, los valores del PCT-Q son más elevados a mayor gravedad del MPI. Valores mayores de 10/ng/ml de PCT-Q son significativos para el ingreso en UCI y mal pronóstico del cuadro clínico (AU)

Introduction It has been shown that procalcitonin (PCT) is a good marker for sepsis as the more severe the infection the higher the plasma levels. The Mannheim peritonitis index (MPI) is very effective in assessing the prognosis of secondary peritonitis. The aim of this study is to find out whether there is any correlation between preoperative PCT levels and the postoperative MPI, as well as the prognostic value of preoperative PCT levels. Patients and method Prospective study of 57 patients operated on between December 2006 August 2008 for secondary peritonitis and classified into three groups (A: 23 patients, B: 24 patients and C: 10 patients) from lowest to highest severity of MPI. The preoperative values of procalciton in were obtained with PCT-Q test (BRAHMS). Results PCT-Q was normal (<0.5ng/ml) in 19 patients in group A, in 2 patients in group B and none in group C (p<0.001). PCT-Q between 2 10ng/ml were found in one patient in group A, 13 in group B and none in group C (p<0.001). PCT-Q >10ng/ml were found in 10 cases in group C, 6 in group B and none in group A (p<0.001). Of the 19 patients admitted to the intensive care unit, the PCT-Q was >10ng/ml in 15 cases vs a PCT-Q<10mg/ml (p<0.001) in 4 cases. Seven patients died, all of them with a PCT-Q >10mg/ml (p<0.001).Conclusions The correlation between preoperative PCT-Q and postoperative MPI is positive and significant. The values of PCT-Q are higher as the MPI severity increases. Values >10ng/ml are significant for admission to the ICU and a poor clinical prognosis (AU)

[Prospective study of procalcitonin as a diagnostic marker of the severity of secondary peritonitis]. / Estudio prospectivo de la procalcitonina como marcador diagnóstico de gravedad en la peritonitis secundaria.

INTRODUCTION: It has been shown that procalcitonin (PCT) is a good marker for sepsis as the more severe the infection the higher the plasma levels. The Mannheim peritonitis index (MPI) is very effective in assessing the prognosis of secondary peritonitis. The aim of this study is to find out whether there is any correlation between preoperative PCT levels and the postoperative MPI, as well as the prognostic value of preoperative PCT levels. PATIENTS AND METHOD: Prospective study of 57 patients operated on between December 2006-August 2008 for secondary peritonitis and classified into three groups (A: 23 patients, B: 24 patients and C: 10 patients) from lowest to highest severity of MPI. The preoperative values of procalcitonin were obtained with PCT-Q test (BRAHMS). RESULTS: PCT-Q was normal (<0.5ng/ml) in 19 patients in group A, in 2 patients in group B and none in group C (p<0.001). PCT-Q between 2-10ng/ml were found in one patient in group A, 13 in group B and none in group C (p<0.001). PCT-Q >10ng/ml were found in 10 cases in group C, 6 in group B and none in group A (p<0.001). Of the 19 patients admitted to the intensive care unit, the PCT-Q was >10ng/ml in 15 cases vs a PCT-Q<10mg/ml (p<0.001) in 4 cases. Seven patients died, all of them with a PCT-Q >10mg/ml (p<0.001). CONCLUSIONS: The correlation between preoperative PCT-Q and postoperative MPI is positive and significant. The values of PCT-Q are higher as the MPI severity increases. Values >10ng/ml are significant for admission to the ICU and a poor clinical prognosis.

[Laparoscopic treatment of perforated duodenal ulcer]. / Tratamiento laparoscópico de la úlcera duodenal perforada.

OBJECTIVE: To analyze the results obtained in patients undergoing laparoscopic surgery for perforated duodenal ulcer. PATIENTS AND METHOD: From January 2000 to August 2006, 15 consecutive patients with perforated duodenal ulcer underwent laparoscopic surgery after preoperative selection (ASA scores, time since onset of the perforation). RESULTS: The mean age was 44.6 +/- 15.5 years (range, 18-75). There were 10 men and five women. Fourteen patients were ASA I-II. Time since onset of perforation was more than 12 hours in only one patient. Operative time was 70.5 +/- 9.6 minutes. There were two conversions (13.3%) to the open approach and two postoperative complications (prolonged ileus in one patient and self-limiting leakage in another). There were no intra-abdominal collections or mortality in the entire series. The mean length of hospital stay was 6.5 +/- 2.1 days. CONCLUSIONS: In selected patients, laparoscopic treatment of perforated duodenal ulcer is safe and feasible. Technical standardization and appropriate patient selection are essential to define the real role of the laparoscopic approach in perforated duodenal ulcer.

Tratamiento laparoscópico de la úlcera duodenal perforada / Laparoscopic treatment of perforated duodenal ulcer

Objetivo. Analizar los resultados obtenidos en los pacientes intervenidos de úlcera duodenal perforada por vía laparoscópica. Pacientes y método. Quince pacientes intervenidos consecutivamente desde enero de 2000 hasta agosto de 2006, previa selección preoperatoria (ASA y tiempo de evolución de la perforación). Resultados. La media de edad del grupo era de 44,6 ± 15,5 (intervalo, 18-75) años; 10 varones y 5 mujeres; 14 pacientes fueron clasificados como ASAI-II. Sólo en un paciente la duración de la clínica de perforación fue > 12 h. El tiempo quirúrgico fue de 70,5 ± 9,6 min. Se han producido 2 (13,3%) conversiones a cirugía abierta y 2 complicaciones postoperatorias: un paciente presentó íleo y el otro caso, una fístula autolimitada. No se han evidenciado dehiscencias de la sutura duodenal o absceso intraabdominal. No se han producido reintervenciones ni mortalidad. La estancia media hospitalaria fue de 6,5 ± 2,1 días. Conclusiones. En casos seleccionados el tratamiento laparoscópico de la úlcera duodenal perforada es seguro y factible. La estandarización de la técnica y una adecuada selección de los casos son las claves que, en un futuro, deberemos desarrollar a fin de establecer cuál es el papel real del tratamiento laparoscópico en la úlcera duodenal perforada (AU)

Objective. To analyze the results obtained in patients undergoing laparoscopic surgery for perforated duodenal ulcer. Patients and method. From January 2000 to August 2006, 15 consecutive patients with perforated duodenal ulcer underwent laparoscopic surgery after preoperative selection (ASA scores, time since onset of the perforation). Results. The mean age was 44.6 ± 15.5 years (range, 18-75). There were 10 men and five women. Fourteen patients were ASA I-II. Time since onset of perforation was more than 12 hours in only one patient. Operative time was 70.5 ± 9.6 minutes. There were two conversions (13.3%) to the open approach and two postoperative complications (prolonged ileus in one patient and self-limiting leakage in another). There were no intra-abdominal collections or mortality in the entire series. The mean length of hospital stay was 6.5 ± 2.1 days. Conclusions. In selected patients, laparoscopic treatment of perforated duodenal ulcer is safe and feasible. Technical standardization and appropriate patient selection are essential to define the real role of the laparoscopic approach in perforated duodenal ulcer (AU)

Tratamiento laparoscópico de la colecistitis aguda: análisis de resultados / Laparoscopic treatment of acute cholecystitis: analysis of the results

Introducción. El objetivo de este estudio es la evaluación de nuestros resultados obtenidos con el tratamiento laparoscópico precoz en la colecistitis aguda. Pacientes y método. Se estudió a los pacientes intervenidos de colecistitis aguda mediante colecistectomía laparoscópica precoz durante el período comprendido entre julio de 1993 y enero de 2002. Con anterioridad al estudio se establecieron 5 criterios de selección para su acceso laparoscópico: a) diagnóstico clínico-analítico-ecográfico de colecistitis aguda; b) inicio de los síntomas no superior a las 72 h; c) analítica hepática normal y vía biliar principal no dilatada y sin imágenes sugestivas de litiasis coledocal en la exploración ecográfica; d) estado general del paciente sin contraindicación para la laparoscopia, y e) ausencia de cirugía supramesocólica. Resultados. Un total de 158 pacientes fueron tratados por colecistitis aguda. De ellos, en 73 enfermos (46,2 por ciento) se llevó a cabo colecistectomía laparoscópica precoz y en 12 casos fue preciso realizar conversión a cirugía abierta (16,4 por ciento). Presentaron complicaciones 9 pacientes (12,3 por ciento), y cuatro precisaron reintervención, uno de ellos por una lesión de la vía biliar principal, dos por hemoperitoneo por hemorragia del lecho hepático y uno por absceso intraabdominal. La estancia media fue de 5,6 días. Conclusiones. Los resultados de este estudio han demostrado que el uso de la colecistectomía laparoscópica precoz en la colecistitis aguda es seguro y factible (AU)

Hiperplasia nodular focal. Presentación de un caso pediátrico y revisión de la literatura

Los tumores hepáticos primarios representan menos del 2 porciento de las neoplasias en la infancia La hiperplasia Nodular Focal junto con el adenoma hepático representan menos del 4 porciento de los tumores del hígado. Se presenta una niña de 6 meses con esta enfermedad y se revisan en la literatura los aspectos etiopatogénicos y terapéuticos de la misma